Exiting the Emergency Medical Services Profession and Characteristics Associated with Intent to Return to Practice

Prehosp Emerg Care. Jan-Feb 2018;22(1):28-33. doi: 10.1080/10903127.2017.1339749. Epub 2017 Jun 28.


Objective: Inadequate staffing of agencies, increasing attrition rates, and frequent turnover of personnel make employee retention an ongoing concern for Emergency Medical Services (EMS). Faced with increasing demand for EMS, understanding the causes underlying turnover is critical. The objectives of this study were to describe the proportion of individuals that left EMS, likelihood of returning to the profession, and key factors contributing to the decision to leave EMS.

Methods: This was a cross-sectional study of nationally-certified EMS professionals who left EMS. Respondents to a census survey who reported not practicing EMS were directed to a subsection of items regarding their choice to leave EMS. Demographic and employment characteristics, likelihood of returning to EMS, and factors influencing the decision to leave EMS were assessed. Descriptive and comparative statistics (Chi-square and nonparametric test of trend [p-trend]) and univariable odds ratios were calculated.

Results: The overall response rate for the full survey was 10% (n = 32,114). A total of 1247 (4%) respondents reported leaving the profession and completed the exit survey. The majority (72%) reported that they will likely return to EMS. A stepwise decrease in the reported likelihood of returning was seen with increasing years of EMS experience (e.g., 2 or less years of experience: 83%; 16 or more years: 52%; p-trend < 0.001) and months away from EMS (e.g., 0-2 months: 89%; more than 12 months: 57%; p-trend < 0.001). The most common factors reported to influence the decision to leave EMS included desire for better pay/benefits (65%), decision to pursue further education (60%), dissatisfaction with organization's management (54.7%), and desire for career change (54.1%).

Conclusion: This cross-sectional study found an attrition rate of approximately 4% among nationally certified EMS professionals; however, the majority reported that they intended to return to the EMS profession. Intention to return to EMS decreased as years of experience and months away from the profession increased. Important factors in the decision to leave EMS included a desire for better pay and benefits and the decision to pursue further education. Targeting the factors identified as important in this study should be a priority for key stakeholders in improving recruitment and retention of EMS professionals.

Keywords: emergency medical services; emergency medical technicians; exit; paramedics; turnover intentionst.

MeSH terms

  • Career Choice
  • Cross-Sectional Studies
  • Decision Making*
  • Emergency Medical Services / statistics & numerical data*
  • Emergency Medical Technicians / statistics & numerical data*
  • Female
  • Humans
  • Intention
  • Job Satisfaction
  • Male
  • Registries
  • Return to Work / statistics & numerical data*
  • Surveys and Questionnaires
  • United States